Recurrent Diverticulitis Research Articles

Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study.

Acute right colic diverticulitis (ARD) is less frequent in Western countries than acute sigmoid diverticulitis (ASD). We aimed to compare the management of ARD and ASD operated on in emergency. All consecutive patients who had emergency surgery for ASD and ARD (2010-2021) were included in a retrospective, multicenter, cohort study. Patients were identified from databases in French centers that were members of the French Surgical Association. Emergency surgery was performed during the same hospitalization for peritonitis or after failure of conservative treatment. Early and late postoperative outcomes were studied. A total of 2297 patients were included with 2256 (98.2%) ASD and 41 (1.8%) ARD patients. Baseline characteristics were similar. Overall, patients were rated Hinchey 3-4 (63.9%, n = 1468, p = 0.287). ARD was more often treated with resection and anastomosis, protected or not (53.7%, n = 22), whereas ASD was mainly treated with resection and terminal ostomy (62.5% (n = 1409), p < 0.001). Median operative time was shorter for ARD (120 vs 146min, p = 0.04). The group of ARD patients showed a higher prevalence of Clavien III/IV complications compared to the group of ASD patients, although no statistically significant difference was observed (41.5%, n = 17 vs. 27.6%, n = 620, p = 0.054). However 90-day mortality only happened in ASD patients (9.8%, n = 223 vs 0, p = 0.03). ARD patients had more diverticulitis recurrence (46.3%, n = 19 vs 13.4%, n = 303, p < 0.001). Multivariate analysis identified female sex as a protective factor for recurrence [odds ratio (OR) 0.55, p < 0.001] and ARD as a risk factor (OR 8.85, p < 0.001). Operated on in emergency, ARDs have more resection anastomosis, with a similar rate of complications, less mortality, and more recurrence of diverticulitis than ASD.

Long-term Follow-up After an Initial Episode of Diverticulitis: A 13- Year Update.

For patients with recurrent diverticulitis, the trigger to proceed to elective sigmoid colectomy is unclear. Current clinical practice guidelines suggest this is an individualized decision between surgeon and patient. To assess long-term risk of diverticulitis recurrence and determine predictors of recurrent disease. Retrospective case series. Tertiary care center. Consecutive patients with CT-proven diverticulitis who presented as inpatient or outpatient between 2002-2008. Incidence of diverticulitis recurrence determined via chart review and questionnaire. Risk of recurrent diverticulitis or surgery for diverticulitis. A total of 753 patients with first-time diverticulitis were identified. Patients were 61.5 years old (SD 15.3). Median follow-up was 13.2 years (IQR 3.8-18.3). There were 486 (64.5%) patients alive at time of follow-up. During initial presentation, 29 (3.9%) required IR drainage and 37 (4.9%) required emergency surgery. Forty-three (5.7%) underwent elective surgery after initial presentation, and 77 (10.2%) underwent surgery after more than 1 episode. Of those without surgery for first episode, 353 (52.4%) experienced recurrent disease with median time to recurrence of 2.9 years (IQR 0.83-8.5 years). On multivariate analysis, female sex (HR 1.28, p = 0.04), sigmoid disease (HR 1.35, p = 0.03), smoldering disease (HR 3.17, p < 0.01), length of involved segment >5 cm (HR 1.28, p = 0.04), and maximum fat stranding diameter >1.8 cm (HR 1.29, p = 0.03) were associated with disease recurrence. Kaplan Meier estimates of freedom from recurrence were 73.1% (69.6-76.3%) at 1 year, 47.9% (44.0-51.6%) at 5 years, and 34.6% (31.0-38.2%) at 10 years following initial presentation. Retrospective design. After a single episode of diverticulitis, incidence of recurrence is more than 50% on long-term follow-up. Variables such as female sex, sigmoid disease, smoldering disease, length of involved segment greater than 5 cm, and maximum fat stranding diameter greater than 1.8 cm were associated with an increased risk of recurrence. These findings should be considered when counseling patients on decision to proceed with elective colectomy. See Video Abstract.

Success in Diverticulitis Management: What Outcomes Really Matter?

AbstractAchieving optimal outcomes is a universal goal among health care providers. However, disagreement often arises when selecting and measuring endpoints as markers of care performance. In diverticulitis, this task is complicated by variability in clinical presentation and existence of multiple evidence-based therapeutic options. The aim of this review is to summarize trends and challenges in outcomes measurement for diverticulitis. We discuss historical origins and compare existing frameworks for classifying outcomes. Next, focus is directed to an exploration of important outcomes through clinical controversies: antibiotics for acute uncomplicated diverticulitis, colectomy with primary anastomosis for acute complicated diverticulitis, and elective colectomy for recurrent diverticulitis. Finally, we review recommendations supporting case-by-case decision-making and implications for clinicians, in addition to ongoing international efforts to standardize outcomes that matter for common diseases.

S4586 Pyogenic Liver Abscesses as a Unique Complication of Recurrent Diverticulitis

S4586 Pyogenic Liver Abscesses as a Unique Complication of Recurrent Diverticulitis

Rare symptom of left inguinal abscess secondary to a retroperitoneal perforation of diverticulitis of the sigmoid colon: A case report.

Complicated colorectal diverticulitis could be fatal, and an abscess caused by this complication is usually formed at the pericolic, mesenteric, or pelvic abscess. Therefore, we report a rare case of sigmoid colon diverticulitis that developed a large inguinal abscess. A woman in her 70s was admitted to our hospital with a chief complaint of left inguinal swelling and tenderness 1 week before admission. Physical examination showed swelling, induration, and tenderness in the left inguinal region. Blood tests revealed elevated inflammatory reaction with C-reactive protein of 11.85 mg/dL and white blood cells of 10,300/μL. Contrast-enhanced computed tomography showed multiple colorectal diverticula in the sigmoid colon, edematous wall thickening with surrounding fatty tissue opacity, and abscess formation with gas in the left inguinal region extending from the left retroperitoneum. The diagnosis was sigmoid colon diverticulitis with large abscess formation in the left inguinal region. Immediate percutaneous drainage of the left inguinal region was performed, as no sign of panperitonitis was observed. Intravenous piperacillin-tazobactam of 4.5 g was administered every 6 hours for 14 days. The inflammatory response improved, with C-reactive protein of 1.11 mg/dL and white blood cell of 5600/μL. Computed tomography of the abdomen confirmed the disappearance of the abscess in the left inguinal region, and complete epithelialization of the wound was achieved 60 days after the drainage. The patient is under observation without recurrence of diverticulitis. We report a rare case of sigmoid colon diverticulitis that developed a large inguinal abscess, which was immediately improved by percutaneous drainage and appropriate antibiotics administration.

SP5.3 - Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: Time to change the traditional practice

Abstract Background To evaluate comparative outcomes of outpatient versus inpatient treatment and antibiotics versus no antibiotics approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis. The protocol of this review was registered in PROSPERO (CRD42023488826). Methods A systematic online search was conducted using electronic databases. Comparative studies of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis were included. The primary outcome was diverticulitis recurrence. Emergency surgical resection, elective surgical resection, development of complicated diverticulitis, mortality rate, and length of hospital (LOS) were the other evaluated secondary outcomes. Results The literature search identified 14 studies (n=3,875) comparing NABX (n=2,008) versus ABX (n=1,867). The NABX group showed a lower disease recurrence rate and shorter LOS compared with the ABX group (P=0.01) and (P=0.004). No significant difference was observed in emergency resections (P=0.33), elective resections (P=0.73), development of complicated diverticulitis (P=0.65), hospital re-admissions (P=0.65) and 30-day mortality rate (P=0.91). Twelve studies (n=2,286) compared OP (n=1,021) versus IP (n=1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P=0.10), emergency surgical resection (P=0.40), elective resection (P=0.30), diverticulitis recurrence (P=0.22), and mortality (P=0.61). Conclusion Compared with the use of ABX, the NABX approach seems to provide similar clinical outcomes and shorter LOS. Moreover, OP treatment of Hinchey 1a acute diverticulitis is comparable with IP management and presumably leads to cost savings in depleted healthcare systems

FP1.5 - Safety and efficacy of Ambulatory treatment of uncomplicated acute diverticulitis: A two-centre cohort study and a proposal of an Ambulatory pathway

Abstract Aim This study aimed to assess the safety and efficacy of ambulatory treatment in patients with uncomplicated acute diverticulitis (AD) compared with inpatient treatment. Methods This is a retrospective comparative study conducted in two hospitals. All patients presented to the emergency department with CT-confirmed Hichney 1a AD during the period from 01/01/2022 to 31/12/2022 were included in this study. Patients with complicated diverticulitis or CT was not performed were excluded. All patients were followed for 12 months for re-admission and AD recurrence. Data analysis was performed with SPSS 27. Results A total of 137 patients were presented during the study period with CT-confirmed Hinchey 1a AD. The median age was 62 (24-94) years old, with a female-to-male ratio of 1.7:1. In the majority of patients (75.9%), WBCS was &amp;lt; 15 and CRP &amp;lt; 100. Moreover, 37.2% had previous AD, and it was complicated in 5.8%. For 12 months of follow-up, 19% of the cases developed diverticulitis recurrence. However, only 1 patient required surgery, and no patient required radiology intervention. No mortality was reported. A luminal investigation (CT colonoscopy or endoscopy) was organized in 61.3%, and colon cancer was detected in one patient. A comparison of patients who were treated as ambulatory (n=35) versus inpatient (n= 102) showed no significant difference regarding re-admission and recurrence of AD (P= 0.22) and surgical intervention (P=0.5) during 1-year follow-up. Conclusion With comparable results to inpatient treatment, the Ambulatory treatment of Hinchey 1a AD is safe and feasible and provides a reduction of treatment expenses.

Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study.

Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking. This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.

The Role of Dietary Fiber in Gastrointestinal Health: Focus on Irritable Bowel Syndrome and Diverticular Disease

Dietary fiber (DF) encompasses a variety of plant-derived carbohydrates resistant to human digestive enzymes, significantly influencing gastrointestinal health. This study examines the role of DF in managing Irritable Bowel Syndrome (IBS) and Diverticular Disease (DD), utilizing comprehensive analysis from PubMed, Google Scholar, and Embase. IBS, affecting 10-20% globally, involves complex brain-gut interactions, motility issues, and microbiota changes. Soluble fiber like psyllium reduces IBS symptoms by improving stool consistency and regulating bowel movements. However, the role of DF in DD is more nuanced. While the reports on the impact on diverticulosis prevalence are contradictory, numerous moderate-quality studies confirmed the protective effect against recurrent diverticulitis and hospitalization. The effect of different fiber types on this matter was not widely explored which might explain the discordances between the studies. Further research is essential to fully understand the diverse effects of different types of DF on gastrointestinal (GI) health. This way, exhaustive guidelines specific to each fiber type and disease phenotype could be developed, allowing to tailor the dietary recommendations to each patient, optimizing the management of symptoms of IBS and DD, and improving the quality of life.

Acute diverticulitis: beyond the diagnosis: predictive role of CT in assessing risk of recurrence and clinical implications in non-operative management of acute diverticulitis

PurposeThe aim of the study is to identify CT findings that are predictive of recurrence of acute uncomplicated colonic diverticulitis, to better risk-stratify these patients for whom guidelines recommend a conservative outpatient treatment and to determine the appropriate management with an improvement of health costs.Materials and MethodsOver the past year, 33 patients enrolled in an outpatient integrated care pathway (PDTA) for uncomplicated acute diverticulitis with 1-year follow-up period, without recurrence, and 33 patients referred to Emergency Department for a recurrent acute diverticulitis were included. Images of admission CT were reviewed by two radiologists and the imaging features were analyzed and compared with Chi-square and Student t tests. Univariate and multivariate Cox regression models were employed to identify parameters that significantly predicted recurrence in 1-year follow-up period and establish cutoff and recurrence-free rates. The maximally selected rank statistics (MSRS) were used to identify the optimal wall thickening cutoff for the prediction of recurrence.ResultsPatients with recurrence showed a greater mean parietal thickness compared to the group without recurrence (16 mm vs. 11.5 mm; HR 1.25, p < 0.001) and more evidence of grade 4 of peridiverticular inflammation (40% vs. 12%, p = 0.009, HR 3.44). 12-month recurrence-free rates progressively decrease with increasing thickness and inflammation. In multivariate analysis, only parietal thickness maintained its predictive power with an optimal cutpoint > 15 mm that causes a sixfold increased risk of recurrence (HR 6.22; 95% CI, 3.05–12.67; p < 0.001). Beyond thickness and peridiverticular inflammation, predictive value of early recurrence within 90 days from the 1st episode resulted also an Hinchey Ib on admission CT.ConclusionsThe maximum wall thickening and the grade of peridiverticular inflammation can be considered as predictive factors of recurrence and may be helpful in selecting patients for a tailored treatment to prevent the risk of recurrence.

Robotic ambulatory colorectal resections: a systematic review.

Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have greatly shortened, allowing for same day discharges (SDD). Although SDD have been explored through laparoscopic colectomy reviews, no reviews surrounding robotic ambulatory colorectal resections (RACrR) exist to date. A systematic search was carried out across three databases and internet searches. Data were selected and extracted by two independent reviewers. Inclusion criteria included robotic colorectal resections with a length of hospital stay of less than one day or 24h. 4 studies comprising 136 patients were retrieved. 56% of patients were female and were aged between 21 and 89years. Main surgery indications were colorectal cancer and recurrent sigmoid diverticulitis (43% each). Most patients had low anterior resections (48%). Overall, there was a 4% complication rate postoperatively, with only 1 patient requiring readmission due to postoperative urinary retention (< 1%). Patient selection criteria involved ASA score cut-offs, nutritional status, and specific health conditions. Protocols employed shared similarities including ERAS education, transabdominal plane blocks, early removal of urinary catheters, an opioid-sparing regime, and encouraged early oral intake and ambulation prior to discharge. All 4 studies had various follow-up methods involving telemedicine, face-to-face consultations, and virtual ward teams. RACrRs is safe and feasible in a highly specific patient population; however, further high-quality studies with larger sample sizes are needed to draw more significant conclusions. Several limitations included small sample size and the potential of recall bias due to retrospective nature of 2 studies.

Proportion of Colonic Diverticulosis and Its Associated Factors among Patients Underwent Colonoscopy

Aim: Diverticular disease is one of the most common gastrointestinal disorders to date, with a notable rising trend in developing countries. However, the proportion of colonic diverticulosis and its associated factors among patients who have undergone colonoscopy remains controversial. This study aimed to determine the local data on the proportion of diverticular disease in the community, its complications, the association of diverticulosis with diabetes mellitus and hypertension, as well as demographic characteristics. Material and Methods: A retrospective review of medical records was performed among patients who had undergone colonoscopy between January and December 2019. Demographic and clinical characteristics, the presence of diabetes mellitus, hypertension, and diverticular disease and its complications were examined, and the association of diverticular disease and its complications with demographic and clinical characteristics were analyzed. Results: Out of 221 patients, 12.7% (n=28) of them had diverticular diseases with a slightly predominant right-sided occurrence (42.9%, n=12). There were significant associations with age (p=0.002), ethnicity (p=0.011), and hypertension (p=0.036), but not with gender and diabetes mellitus (p=0.261, and p=0.334, respectively). There was no significant association between hypertension and recurrence of complicated diverticulitis (p=0.741), septic complications (p=0.678), and diverticular bleeding (p=0.243). Diabetes mellitus was significantly associated with diverticular bleeding complications (p=0.001) but not with septic complications (p=0.418) and recurrence of complicated diverticulitis (p=0.629). Conclusion: This study showed almost a similar percentage of diverticulosis compared to previous local studies. Age, ethnicity, and hypertension were associated with the presence of diverticulosis, and diabetes mellitus was associated with diverticular bleeding.

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

BackgroundTo evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis.MethodsA systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters.ResultsThe literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61).ConclusionObservation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.

Operative versus nonoperative management for diverticulitis complicated by abscess

A clinical decision report using: You K, Bendl R, Taut C, et al. Randomized clinical trial of elective resection versus observation in diverticulitis with extraluminal air or abscess initially managed conservatively. Br J Surg. 2018;105(8):971-979. https://doi.org/10.1002/bjs.10868 for a patient with a recurrent diverticulitis complicated by abscess formation.

Recurrence of severe diverticulitis is associated with age and birth decade

BackgroundThe risk of recurrence is an important consideration when deciding to treat patients medically or with elective colectomy after recovery from diverticulitis. It is unclear whether age is associated with recurrence. This study aimed to examine the relationship between age and the risk of recurrent diverticulitis while considering important epidemiologic factors, such as birth decade. MethodsThe Utah Population Database was used to identify individuals with incident severe diverticulitis, defined as requiring an emergency department visit or hospitalization, between 1998 and 2018. This study measured the relationship between age and recurrent severe diverticulitis after adjusting for birth decade and other important variables, such as sex, urban/rural status, complicated diverticulitis, and body mass index using a Cox proportional hazards model. ResultsThe cohort included 8606 individuals with a median age of 61 years at index diverticulitis diagnosis. After adjustment, among individuals born in the same birth decade, increasing age at diverticulitis onset was associated with an increased risk of recurrent diverticulitis (hazard ratio [HR] for 10 years, 1.8; 95% CI, 1.5–2.1). Among individuals with the same age of onset, those born in a more recent birth decade were also at greater risk of recurrent diverticulitis (HR, 1.9; 95% CI, 1.6–2.3). ConclusionAmong individuals with an index episode of severe diverticulitis, recurrence was associated with increasing age and more recent birth decade. Clinicians may wish to employ age-specific strategies when counseling patients regarding treatment options after a diverticulitis diagnosis.

The Patient Perspective on Colectomy for Recurrent Diverticulitis: A Qualitative Study.

Understand the patient's decision-making process regarding colectomy for recurrent diverticulitis. The decision to pursue elective colectomy for recurrent diverticulitis is highly preference-sensitive. Little is known about the patient's perspective in this decision-making process. We performed a qualitative study utilizing focus groups of patients with recurrent diverticulitis at 3 centers across the United States. Using an iterative inductive/deductive approach, we developed a conceptual framework to capture the major themes identified in the coded data. From March 2019 to July 2020, 39 patients were enrolled across 3 sites and participated in 6 focus groups. After coding the transcripts using a hierarchical coding system, a conceptual framework was developed. Major themes identified included participants' beliefs about surgery, such as normative beliefs (eg, subjective, value placed on surgery), control beliefs (eg, self-efficacy, stage of change), and anticipated outcomes (eg, expectations, anticipated regret); the role of behavioral management strategies (eg, fiber, eliminate bad habits); emotional experiences (eg, depression, embarrassment); current symptoms (eg, severity, timing); and quality of life (eg, cognitive load, psychosocial factors). Three sets of moderating factors influencing patient choice were identified: clinical history (eg, source of diagnosis, multiple surgeries), clinical protocols (eg, pre-op and post-op education), and provider-specific factors (eg, specialty, choice of surgeon). Patients view the decision to undergo colectomy through 3 major themes: their beliefs about surgery, their psychosocial context, and moderating factors that influence participant choice to undergo surgery. This knowledge is essential both for clinicians counseling patients who are considering colectomy and for researchers studying the process to optimize care for recurrent diverticulitis.

Perforated mucinous diverticulitis of the appendix: a case report

Acute right lower quadrant (RLQ) abdominal pain typically raises the suspicion of appendicitis and must be ruled out, as the treatment is primarily surgical. Other differentials, many of which are medically treated, ought to also be considered. Right sided diverticulitis, although uncommon, often mimics appendicitis due to its inflammatory nature and its location of pain. A 37-year-old woman with a history of recurrent right-sided diverticulitis presented with rapidly escalating RLQ pain. While appendicitis was a prime suspect, additional imaging was refused due to radiation concerns, hence clinical judgement had to be aptly applied. Facing diagnostic ambiguity, Hickam's dictum (seeking the most probable cause) pointed towards appendicitis, while Ockham's razor (favouring the simplest explanation) supported recurrent right sided diverticulitis. This uncertainty necessitated a definitive approach, weighing up the risks and benefits of medical vs surgical treatment for an unconfirmed pathology. To resolve the uncertainty, a diagnostic laparoscopy was performed. Contrary to expectations, it revealed a perforated diverticulum of the appendix with a mucinous tip and free-floating mucin, making both leading differentials, that is, right sided diverticulitis and appendicitis, correct. We explore the diagnostic reasoning used in the case, including the anticipated management strategies and outcomes, if other differentials were encountered. This case aims to support clinicians in pursuing further investigations, or need be, a diagnostic laparoscopy, in order to prioritise patient safety, if clinical concern is present.

Elective Laparoscopic Sigmoidectomy Reduces IL-6 Serum Levels in Uncomplicated Recurrent Diverticulitis.

Introduction: Although recurrent diverticulitis appears to be a chronic relapsing disease from a clinical standpoint, there are no sufficient data about inflammatory markers that allow monitoring recurrent diverticulitis in the quiescent phase. Our hypothesis is that serum inflammatory markers may be increased during clinical quiescent phases of diverticulitis and will drop after elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis. We also believe that a drop in IL-6 levels across surgery could be related to an improved quality of life. Material and Methods: This epidemiological study aims to evaluate IL-6 serum levels and quality of life preoperatively and 6 months after surgery in 30 patients undergoing elective laparoscopic sigmoidectomy for uncomplicated recurrent diverticulitis. Results: The mean preoperative IL-6 level was 9.5 Ã+- 9.2 pg/ml (range 0-5), while at six months after surgery the mean IL-6 was 4.5 +- 3.5. (p=0.0085). Preoperative QoL measured with the GIQLI questionnaire was 98 +- 11.3 and raised significantly after surgery to 112 +- 9.8 (p=0.043). Conclusions: We found a serum IL-6 reduction after elective laparoscopic sigmoidectomy that can be attributed to the surgical removal of the source of inflammation in patients suffering from uncomplicated recurrent diverticulitis. Similarly, the GIQLI questionnaire showed a significantly improved QoL after surgery.

Unmet needs in treatment of symptomatic uncomplicated diverticular disease and prevention of recurrent acute diverticulitis: a scoping review.

Diverticular disease (DD) represents a common gastrointestinal condition that poses a heavy burden on healthcare systems worldwide. A high degree of uncertainty surrounds the therapeutic approaches for the control of symptoms in patients with symptomatic uncomplicated diverticular disease (SUDD) and primary and secondary prevention of diverticulitis and its consequences. To review the current knowledge and discuss the unmet needs regarding the management of SUDD and the prevention of acute diverticulitis. Randomized trials, observational studies, and systematic reviews on lifestyle/dietary interventions and medical treatment (rifaximin, mesalazine, and probiotics) of SUDD or prevention of acute diverticulitis. The literature search was performed from inception to April 2023, without language restriction, following the modified Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) reporting guidelines. References of the papers selected were checked to identify additional papers of potential interest. The final list of references was evaluated by a panel of experts, who were asked to check for any lack of relevant studies. Information on patient population, study design, intervention, control group, duration of the observation, and outcomes assessed was collected by two authors independently. The review shows a high degree of uncertainty about therapeutic interventions, both dietary/lifestyle and pharmacological, in patients with SUDD, because of the scarcity and weakness of existing evidence. Available studies are generally of low quality, heterogeneous, and outdated, precluding the possibility to draw robust conclusions. Similarly, acute diverticulitis prevention has been seldom investigated, and there is a substantial lack of evidence supporting the role of dietary/lifestyle or pharmacological approaches to reduce the risk of diverticulitis. The lack of robust evidence regarding therapeutic options for gastrointestinal symptoms in SUDD patients and for primary and secondary prevention of acute diverticulitis remains an important unmet need in the management of DD.

Outcomes of initially nonoperative management of diverticulitis with abscess formation in immunosuppressed patients. DIPLICAB study COLLABORATIVE group.

Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery. A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS. A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57-7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01-4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26-2.83), use of morphine, p < 0.001; OR: 3.08 (1.98-4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33-2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001-1.002) were independently associated with emergency surgery in IMS. Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.